Appendix 5: Examples of medicines which should not be packed in DAA[1],[2]

Guidance on the stability of medicines in DAA systems is very limited. From the manufacturer’s viewpoint, the removal of any drug from the environment in which it has undergone stability testing, to one where it has not, reduces or invalidates the shelf life indicated on the label. It should be noted that different manufacturers sometimes have varying guidance for the same or similar products. In many cases the pharmacist packing DAA will have to make a judgement on the advisability of incorporating products in them, in the absence of hard information. The pharmacist will need to make a risk assessment on the basis of individual medicines and individual consumers. Reference to Section 6.1 ‘Medicines stability’ of the full guidelines is recommended.

It is imperative that consumers are advised of the medicines which are not packed in the DAA and the labelling which is used to remind consumers to take unpacked medicines.

Pharmacists may wish to use this template to create their own list. Any such list must be updated regularly and appropriate reference sources recorded.

Type of tablet / Examples / Reference source
Effervescent tablets / e.g. effervescent forms of ranitidine, cimetidine, potassium chloride, soluble aspirin tablets
Dispersible tablets / e.g. piroxicam dispersible tablets
Buccal tablets / e.g. nystatin lozenges
Sublingual tablets / e.g. glyceryl trinitrate sublingual tablets, buprenorphine HCl sublingual tablets
Chewable tablets / e.g. Vitamin C
Hygroscopic tablets / e.g. sodium valproate
Tablets exceedingly susceptible to light degradation / e.g. nifedipine, tamoxifen
Heat sensitive tablets
Tablets containing aluminium hydroxide, magnesium trisilicate / e.g. Gaviscon®
Hexamine hippurate tablets
Omeprazole (unless packed monthly)
Moisture-sensitive medicines / Wafer presentations e.g. olanzapine
Other medicines where limited time in DAA may be appropriate / Thyroxine

This template form has been provided as part of PSA’s Dose Administration Aids Service – Guidelines and standards for pharmacists and can be downloaded from PSA’s web site (www.psa.org.au – see under “Policies and Guidelines”). For further information please refer to the full guidelines. PSA takes no responsibility in the use and adaptation of this form by pharmacists.

[1] Church C, Smith J. How stable are medicines moved from original packs into compliance aids? Pharm J 2006; 276:75-81.

[2] Adapted from: Nomad Pharmacy Manual http://www.nomad.co.nz/support/manuals/pharmmancare.htm.